“There is nothing good or attractive about being obese” — Paul Ebeling
For about 100yrs obesity research has been predicated on the belief that the cause of the disorder “is an energy imbalance between calories consumed and calories expended,” to quote the World Health Organization.
Overall with this thinking, obesity is seen as an energy balance disorder. People get fat because they take in more calories than they expend. They stay lean when they do not.
This is the Dogma of obesity science.
Virtually all obesity research is interpreted in the context of this balance principle, and all related public health discussions, not just on obesity but on all the common chronic diseases that associate with it, as well as the very nature of a healthy eating plan, rely fundamentally on its implications.
I did not embraced this thinking, as the prevalence of obesity has risen relentlessly for the past 50yrs+. Obesity with type 2 diabetes, its partner in pathology, is the dominant non-Covid health crisis of our time.
The parallel epidemics of obesity and diabetes are a public health crisis, a director of the WHO has called a slow-motion disaster and the World Bank has called a ticking time bomb. Those assessments were made prior to the appearance of Covid-19, for which obesity and diabetes are 2nd only to advanced age in elevating the likelihood of bad outcomes. The failure to make meaningful progress either treating or preventing obesity cannot be ignored.
The reason I believe that little progress has been made against obesity and type 2 diabetes is because the field has been laboring in the sense intended by philosopher of science Thomas Kuhn, under the wrong paradigm.
This energy-in-energy-out conception of weight regulation is fatally and tragically flawed.
Obesity is not an energy balance disorder, but a hormonal or constitutional disorder, a dysregulation of fat storage and metabolism, a disorder of fuel-partitioning. Because these hormonal responses are dominated by the insulin signaling system, which in turn responds primarily to the carbohydrate content of 1’s eating plan, this thinking is now known as the carbohydrate-insulin model.
Its implications are simple and profound.
People do not get fat because they eat too much, consuming more calories than they expend, but because the carbohydrates in their diets both the quantity of carbohydrates and their quality establish a hormonal milieu that fosters the accumulation of excess fat.
That the environment plays a critical role is a given.
The undeniable evidence is the enormous increase in the prevalence of obesity worldwide. In the US, 12% of Americans lived with obesity 60 yrs ago, more than 40% do today.
Since WWII something changed in the environment, in diets and lifestyles to trigger such a dramatic rise in the prevalence of obesity.
The Big Q: Is it nature or nurture that the environment triggers, behavior or physiology, minds or bodies?
The Big A: Obesity researchers cannot answer it because that is not what they study.
Eating plans that can resolve obesity are not those that induce people to eat less, per energy-balance thinking, but those that reduce circulating levels of insulin, accomplished most effectively by replacing dietary carbohydrates: sugars, starchy vegetables and grains, and the like with fat.
Physicians and diet book authors have been promoting carbohydrate-restricted, high-fat ketogenic diets for 200yrs, most famously Robert Atkins, a New York cardiologist. By arguing, as Dr. Atkins and others did, that fat could be lost without limiting calories by fixing the hormonal dysregulation of fat storage these books were treated as de facto quackery. By advocating that we eat fat-rich foods, they were considered dangerous. I have been following Dr. Atkins’ advice since the beginning, it works.
For researchers and public health authorities to make real progress against obesity and the obesity‑diabetes epidemics, they must shelve their energy-balance thinking, their obsessive focus on how much people eat and exercise.
Instead they have to focus on fat metabolism and storage itself, since by definition excessive accumulation of fat is the underlying abnormality.
Eat healthy, Be be healthy, Live lively